MOC Brings a Smile to Pediatric Patients

On May 18, 2015

Plastic surgeon Donald Mackay, MD, FACS, FAAP, has spent quite a bit of time in foreign countries volunteering for Operation Smile, an organization that provides free surgeries to repair cleft lip, cleft palate, and other facial deformities for children. Working with colleagues from around the globe, he has seen the value in studying alternate techniques. “You might go overseas and think, ‘We have the best way of doing things,’ but there are some incredible surgeons you learn from,” he said.

Still, Dr. Mackay was surprised to learn about a new surgical approach from overseas that seemed to turn conventional wisdom on its head. Conducting research on cleft lip surgery to complete an ABMS Program for Maintenance of Certification (ABMS MOC®) activity, Dr. Mackay came across a study from Poland that concluded performing a septoplasty in children as part of cleft lip surgery had no adverse effects on facial development.

In a child with cleft lip, the septum is usually pulled to one side, slanting at an angle, he explained. A septoplasty involves straightening the tissue. However, most plastic surgeons were taught to avoid this procedure in children. “We were always told never to touch the septum because it affected growth,” said Dr. Mackay, Vice Chair of the Department of Surgery at PennState Hershey College of Medicine. “But this study shows that’s not true. Even if you move the septum, you’re not going to affect the growth of the nose or midface.”

The Polish study had a 14-year follow-up on its young patients, finding that most had no long-lasting problems from the surgery. After reading about this study and conducting further research, Dr. Mackay began performing the procedure on his patients. He and two of his colleagues published an evidence-based MOC article in the May 2014 issue of Plastic and Reconstructive Surgery about the procedure. Dr. Mackay also began sharing their findings and research at MOC seminars where he presented to other plastic surgeons.

The procedure, Dr. Mackay said, adds approximately 15 to 20 minutes to cleft lip surgery, which takes anywhere from 60 to 90 minutes. “You can, and should, do a septoplasty at the same time that you do the lip repair,” he said. “It makes the outcome of the nose look better; a result that is long-lasting.”

Dr. Mackay used the procedure on six children during his latest Operation Smile trip to India in February 2015. The prospect of an improved outcome for these children is another reminder of the value of MOC, he said.

“Getting certification at the end of your training is wonderful, but we can’t just leave it there,” said Dr. Mackay, who serves as MOC Chair for the American Board of Plastic Surgery. “Medicine changes so much. MOC gives us an opportunity to show our colleagues, but most importantly to show our patients, that we’re keeping up. It’s the right thing to do.”